October 28, 2019
Approach to hyperkalemia :
- True or psodo hyperkalemia
Cause of Psodo hyperkalemia ?
- Tourniquet to tight
- Sample in Anticoagulant tube
If ECG normal Do ABG
ECG change :
- Pecked T wave
- Wide QRS
- Loss p wave
- Short QT
- Prolonged PR
A/ Cardiac stabilization: Ca Gluconate / Chloride
- Peripheral line: Ca gluconate ( Ampule 1g ,2g, Every 1 g in 10 ml NS infused over 3-5 min)
- Central line: Ca chloride
- Repeat ECG after 5 min if still changes >> give a second 1 gm calcium gluconate in 10 ml NSS
- Repeat ECG After 5 minutes if still changes >> give a third 1 gm calcium gluconate in 10 ml NSS over 3-5 minutes
- Repeat ECG and If still have changes arrange for URGENT DYALSIS
- Relative contraindication : if patient is on digioxin ( give 1 gm in 100 ml D5 over 30 min )
- Renal patient if you will give bicarbonate and you will give ca glucnate :Do not give in same line to avoid tissue necrosis and particepate ca in vessel
B/ Intracellular shifting :
Temporary shift k about 4-6 h the k become high again
- If BS >250 just give insulin 10 u iv push
- If BG < 250 give insulin and D 50
How much drop of k when you give insulin ?
- the expected K drop is about 0.5 to 1 mEq in about 15-30 min so repeat the cycle if still high .
- but it will come back in the serum in about 60 minutes if no chelating agent, so Repeat k in 30 m to f\u K level.
- Synergetic effect to insulin u can’t give alone .
- Albuterol:10-20 mg inhalation or 0.5 mg IV
Reduction of about 0.5 mEq per dose
- Evidence to use it in hyperkalemia: If PH <7.2 only
- Look for ionized ca and albumin to avoid tetany ( as alkalosis decrease ionized Ca)